APPLICATION FOR FOREST LANDUSE AGREEMENT

Application No. _____________

The Secretary
Department of Environment and Natural Resources
Visayas Avenue, Diliman
Quezon City

Sir:

In consonance with the provision of P.D. 705 as amended, Executive Order No.192, Series of
1987, Executive Order No. 278, Series of 1987 and all pertinent regulations on the matter, I/We hereby
apply for a Forest Landuse Agreement, the particulars of which are as follows:

Type of Forest land Use: ___________________

Approximate Area: ___________________ ha.

Location: Province _____________________________

Municipality/City _____________________________
Barangay(s) _____________________________
Sitio(s) _____________________________

Boundaries: N :_________________________________________
E :_________________________________________
S :_________________________________________
W:_________________________________________

I/We understand that the filing of this application does not convey the right to enter, occupy or
develop the area applied for, until an agreement has been executed between me/us and the Regional
Executive Director of the Department of Environment and Natural Resources.

All application requirements as stipulated in the regulation are enclosed together with the required
non-refundable application fee of P_______________ .

Very truly yours

_______________________________________ ________________________________
_______________________________________ (Applicant)
Postal Address

_______________________________________
Contact Number/s

REPUBLIC OF THE PHILIPPINES )

Province of ____________________ : S.S.
Municipality of _________________ )

SUBSCRIBED AND SWORN to before me this ______ day of ________ Affiant

exhibited to me his/her Residence Certificate Number A- ___________ issued at
_________________________ on _______________________.

Doc. No.________
Page No.________
Book No. _______
Series of 2010

1
 Annex "A-1"

APPLICATION REQUIREMENTS

Answer YES or NO as appropriate and check () the box if FOUR copies of the relevant
document are attached.

1. Is applicant a government official or employee?

--------------------------------------------------------------------------------------
If YES, WRITTEN PERMISION FROM DEPARTMENT HEAD
2. Is applicant a naturalized Filipino?
-----------------------------------------------------------------------------------------------
If YES, COPY OF CERTIFICATE OF NATURALIZATION
3. Is applicant a corporation, partnership, association or cooperative?
If YES:

 CERTIFICATE OF REGISTRATION WITH SEC/CDA

4. Is applicant using a name, style or trade name other than its true name?
If Yes, CERTIFICATE OF REGISTRATION OF SUCH NAME FROM THE
DEPARTMENT OF TRADE AND INDUSTRY.

4.
INCOME TAX RECEIPTS FOR LAST TWO YEARS

5.
PROOF OF FINANCIAL CAPABILITY to manage and develop the area applied for

6. INDICATIVE MANAGEMENT PLAN

7. PAYMENT OF APPLICATION FEE

8 FREE AND PRIOR INFORM CONSENT/ NCIP CERTIFICATION

9 BIR CERTIFICATION OF ZONAL VALUATION OF THE NEAREST COMMERCIAL ZONE OF THE

MUNICIPALITY.

10 MAP OF THE AREA APPLIED FOR COMPLETE WITH COORDINATES AND TECHNICAL
DESCRIPTION.

2
 Annex “B”

INDICATIVE MANAGEMENT PLAN

I. INTRODUCTION:

Description of the area

II. OBJECTIVES:

General
Specific

III. PROJECT SCHEDULE:

IV. TECHNICAL ASPECTS:

Project activity
Description of production/development
Site development

V. MANAGEMENT ASPECTS:

Organization
Management strategies/policies

VI. FINANCIAL ASPECTS:

Project cost
Sources of funds
Financial Projections

3
 Annex “C”

Republic of the Philippines

Department of Environment and Natural Resources
OFFICE OF THE REGIONAL EXECUTIVE DIRECTOR
Region No. ______

SPECIAL FOREST LANDUSE AGREEMENT

(FLAg) No. _____

Of
_____________________________________
(Second Party)

_____________________________________
(Location of the Area)

This Agreement made and entered into by and between the Regional Executive Director
of Environment and Natural Resources Region No ____ with address at
___________________________________________ for and in behalf of the Republic of the
Philippines hereinafter called the FIRST PARTY and __________________________________
with Office address at ____________________________________________________________
herein referred to as the SECOND PARTY.

WITNESSETH

That FIRST PARTY, as Regional Executive Director (RED) of Department of

Environment and Natural Resources, acting under the authority of Section 1838 of Act No. 2711
known as the Revised Administrative Code, Executive Order 192 as amended and Section 57 of
P.D. 705 as amended, hereby issue to the SECOND PARTY ________ hectares of public land
for _________________________________________for a period of twenty five (25) years to
expire on __________________ located at __________________
_________________________, the description and boundaries shown in the attached sketch map
which forms part of this AGREEMENT, subject to the following conditions:

I. This AGREEMENT is subject to existing pertinent Environmental and Forest

Laws, Rules and Regulations, and those that may be promulgated hereafter;

II. The AGREEMENT herein granted shall be confined within the perimeter of the
parcel of land recommended by the Composite Team thru the Regional Technical Director,
Forest Management Services (RTD-FMS) described herein. No other parcel of public forest land
shall be utilized by the herein SECOND PARTY without first securing therefor the
prior permission of the FIRST PARTY.

III. The area herein granted is a public forest land to the best knowledge and belief
of the parties herein and accordingly, the FIRST PARTY shall not be responsible for any loss
suffered by the SECOND PARTY in case the land is declared private property of another or
otherwise reduced, modified, amended or cancelled as result of prior existing valid private claims
or interest therein;

For and in behalf of the ____________________________

Republic of the Philippines
By:

__________________________ ___________________________
Regional Executive Director SECOND PARTY
FIRST PARTY

_______________________ __________________________
Witness Witness

_______________________ __________________________
Witness Witness

4
 IV. The SECOND PARTY shall utilize the area only for the purpose for
which the AGREEMENT is granted. In the event that the area will be utilized in other
purpose other than what is approved, said use is subject to the prior approval of the
Secretary or his/her duly authorized representative.

V. The SECOND PARTY shall, within six (6) months from the issuance of
the AGREEMENT, delineate and mark on the ground the boundaries of the FLAg area
and its sub-areas under the supervision of the DENR and shall preserve the monuments
and other land marks indicating corners and outlines along the boundaries and within the
confines of the area covered by the AGREEMENT.

VI. The SECOND PARTY shall submit within six (6) months from the
issuance of the AGREEMENT a Comprehensive Management and Development Plan
(CDMP) Said Plan will be submitted to and approved by the RED where the same shall
be deliberated upon by a Committee composed of representatives from the Forestry
Sector. The approved plan shall form part of the AGREEMENT.

VII. Construction of any building of permanent character on the area granted shall be
in accordance with the CDMP to be submitted to the FIRST PARTY upon recommendation of
RTD-FMS who shall prescribe the conditions under which it shall be constructed;

VIII. The SECOND PARTY may construct permanent infrastructure that are
necessary in the development of the area as stated in the submitted CDMP. However, additional
improvement not listed in the submitted plan is subject to prior approval of the SECRETARY or
his/her duly authorized representative.

IX. The annual government share/user’s fee of P__________ shall be paid within
thirty (30) days upon approval of the AGREEMENT and annually thereafter, within the same
month that the FLAg was issued based on the Five Percentum (5%) of the zonal value of the
nearest commercial zone within the Barangay/Municipality or Province whichever is higher as
determined by the Department of Finance/Bureau of Internal Revenue. The same is subject to
change every three (3) years depending on the frequency of the zonal valuation being undertaken
by the BIR.

X. The annual Governments Share shall be paid by the SECOND PARTY without
waiting for any call therefor, and not later than the end of month of the following year the
AGREEMENT was issued. Failure to pay annual government share on the date due, the
SECOND PARTY shall be penalized by additional charges of 8.33% per month of delay or a
total of 100% for one (1) year.

XI. Failure to pay the government share and surcharges without justifiable cause
within one year after the same had become due and after three (3) notices shall be sufficient
grounds for the cancellation of this AGREEMENT;

XII. Government share is not refundable.

For and in behalf of the ___________________________

Republic of the Philippines
By:

__________________________ ___________________________
Regional Executive Director SECOND PARTY
FIRST PARTY

_________________________ ___________________________
Witness Witness

_________________________ ___________________________
Witness Witness

5
 XIII. Payment of government share shall not be construed as an assurance for the
extension or renewal of expired AGREEMENT;

XIV. As a guarantee of the faithful performance of and/or compliance with the Forest
Laws and Regulations and the terms and conditions of the AGREEMENT and the payment of
the government share thereof, the SECOND PARTY shall post a Performance Bond equivalent
to at least Ten Percent (10%) of the Zonal Value of the land but not less than Php10,000.00.

XV. No trees in the AGREEMENT area shall be cut regardless of species, if found
within twenty (20) meters from banks of rivers, creeks or streams and of public roads. In case
said 20 meters strip is bereft of trees, same shall be reforested by the AGREEMENT holder.

XVI. The SECOND PARTY shall strictly observe complete sanitary measures within
the AGREEMENT area to ensure protection of watershed values;

XVIII. The SECOND PARTY shall protect the AGREEMENT area from forest fires
and other forms of forest destructions and place his employees or workers under the direction of a
registered forester or other authorized agents of the Secretary whenever required.

XIX. The AGREEMENT holder shall protect and conserve unique, rare and
endangered flora and fauna identified as such under existing laws, rules and regulations.

XIX. The SECOND PARTY shall not impede, obstruct or in any manner prevent the
passage of legitimate stakeholders and/or other forest users and the public.

XX. The SECOND PARTY shall submit an Annual report of activities showing
developmental activities undertaken in accordance with CDMP. In case of Nipa and
Medicinal/Herbal Plantations; report shall include but not be limited to volume harvested by
species; area planted (in ha.), etc. using the prescribed format as provided for.

XXI. All authorized DENR officials and/or employees shall be allowed enter and
inspect the area, for the purpose of monitoring of compliance to the terms and condition of the
AGREEMENT and the activities therein based on the approved CDMP

XXII. This AGREEMENT shall immediately terminate upon the abolition of the
Corporation;

XXIII. To secure prior approval of the FIRST PARTY or his duly authorized
representative on any changes in the management, ownership or capital stock of the company or
corporation or transfer of a majority of the stock or shares of the company or corporation. Failure
to do so without justifiable cause shall be sufficient ground for the cancellation of the
AGREEMENT;

XXIV. Transfer of the AGREEMENT or any assets of the SECOND PARTY, shall
only be allowed upon approval of the Secretary subject to Provision of Section 24 of DAO;

For and in behalf of the ___________________________

Republic of the Philippines
By:

__________________________ ___________________________
Regional Executive Director SECOND PARTY
FIRST PARTY

_________________________ ___________________________
Witness Witness

_________________________ ___________________________
Witness Witness

XXV. Upon the cancellation of this AGREEMENT, the SECOND PARTY shall not
acquire any right by virtue of the said agreement of claim or whatever kind the second party has
introduced upon the land; Upon cancellation of the AGREEMENT through fault of the
6
SECOND PARTY, the improvements existing thereon shall be forfeited and become the
property of the Government. In case the same is granted to another grantee such
improvement shall be appraised accordingly which shall be the basis in the determination of the
Government Share due thereon.

XXVI Upon the expiration and non-renewal of this agreement the SECOND PARTY
may at the discretion of the FIRST PARTY be allowed to hold the land for the period of not
exceeding ninety (90) days, only for the purpose of removing temporary improvements and
putting the land to its original conditions, Provided, that the SECOND PARTY did not violate
any of the terms and conditions of this AGREEMENT;

XXVII. To surrender to the FIRST PARTY or his duly authorized representative the
AGREEMENT if not to be renewed on the date of expiration, or in case of cancellation,
immediately after the effectivity of its cancellation.

XXVIII. The privilege granted as well as terms and conditions thereof shall be
subject to any and all modifications or alterations as may be necessary.

XXIX. This AGREEMENT may be terminated earlier than the date indicated herein
upon violation of any of the above cited terms and conditions, and the performance bond forfeited
in favor of the government;

XXX. Renewal application must be filed sixty (60) days prior to expiry date in order to
give ample time to process the same.

XXXI. This AGREEMENT is non-transferable and non-negotiable except as provided

in Presidential Degree No. 705 as amended..

Quezon City, Philippines. ______________________________, 20_____.

For and in behalf of the ____________________________

Republic of the Philippines
By:

________________________ ___________________________
Regional Executive Director SECOND PARTY
FIRST PARTY

WITNESSES:

__________________________

__________________________

Recommended By:

_________________________________
Regional Technical Director, Forestry

ACKNOWLEDGEMENT

7
REPUBLIC OF THE PHILIPPINES )
:
Quezon City, Philippines )

BEFORE ME, a Notary Public for and in __________________, Philippines on the ____
day of ___________, 20__, personally appeared the following with their respective certificate
opposite their names:

NAME COM. TAX CERT. NO. DATE/PLACE OF ISSUE

___________________________ ________________ ______________________

___________________________ ________________ ______________________

Known to me to be the same persons who executed the foregoing instruments, and who
acknowledged to me that the same is their free and voluntary act and deed, as well as the free and
voluntary act and deed of the entities represented herein.

This instrument, which is the SPECIAL FOREST LANDUSE AGREEMENT (FLAg)

No. ________, consist of ____ pages including this page when the ACKNOWLEDGEMENT is
written and is signed by the parties and their instrument on each page thereof.

WITNESS MY HAND AND SEAL, at the place and on the date written above.

NOTARY PUBLIC

Doc No. ________

Page No. ________
Book No. ________
Series of ________

Annex “D”

MONITORING AND EVALUATION REPORT FORM

NAME OF AGREEMENT HOLDER:

KIND OF TENURE INSTRUMENT:

8
FOREST LANDUSE AGREEMENT (FLAgT) NO. ______________ (___________________________)
Purpose
FOREST LANDUSE AGREEMENT (FLAg) NO. _______________ (___________________________)
Purpose
SPECIAL LAND USE LEASE AGREEMENT (SPLULA) NO.______________(___________________)
Purpose
SPECIAL LAND USE PERMIT (SLUP) NO. ________________(______________________________)
Purpose

LOCATION OF THE AREA:

AREA IN HECTARE/S:

DATE CONDUCTED:

CONDUCTED BY:

PURPOSE/S:

IMPROVEMENTS INTRODUCED IN THE AREA:

Nature of Improvement Dimension Estimated Value






COMPLIANCE TO THE TERMS AND CONDITIONS OF FLAgT/FLAg/SPLULA/SLUP::








OTHER FINDINGS:





COMMENTS/RECOMMENDATIONS:





SUBMITTED BY:

__________________________

__________________________

COPY FURNISHED
PENRO
RED
FMB
Secretary, DENR
AGREEMENT Holder

9
 Annex “E”

ANNUAL REPORT ON SPECIAL FOREST LANDUSE AGREEMENT

(FLAg) No. __________ for C.Y._____

A. BASIC INFORMATION:

Name of AGREEMENT holder: ____________________________________

Postal Address : ________________________________________________________

Kind of Special Forest Landuse Agreement (FLAg) No. _________

(Type) ____________________________________________________________________

Date Issued:_________________________ Date of Expiration: ___________________

Location: Sitios: _____________________ Barangays: __________________________

Municipality______________________ Province _______________________________

Area _______________ ( in hectares)

B. Improvements introduced in the Area.

Type of improvement Dimension of introduced Previou Current Amount

introduced improvements s Year Value in
Year (P)

C. Government share paid (indicate O.R. No., date and amount paid)
__________________.

D. Other Activities:

This is to certify that the above data and information are true and correct to the best
knowledge of the undersigned.

______________________________________
Signature of the AGREEMENT holder

Subscribed and Sworn to before me this ______ day of_______, 200___,

affiant, __________ exhibited to me his/her Community Tax Certificate No.
__________ issued at ____________ on ___________________ and TIN No.
________, who executed the foregoing report, and acknowledge to me his free that the
same are true and correct to the best of his/her knowledge.

________________________
CENRO/PENRO/RED
(As the case maybe)
Copy Furnished:
CENRO
PENRO
RED
FMB, DIRECTOR
DENR, SECRETARY

10
 Annex “E-1”

ANNUAL REPORT ON SPECIAL FOREST LANDUSE AGREEMENT FOR

NIPA AND HERBAL/MEDICINAL PLANTATION
(FOR C.Y._____)

A. BASIC INFORMATION:

Name of AGREEMENT holder: ___________________________________________

Postal Address : ________________________________________________________
Kind of Special Forest Landuse Agreement (FLAg) No. __________________________
_______________________________________________________________________
Date Issued:_________________________ Date of Expiration: ___________________
Location: Sitios: _____________________ Barangays: __________________________
Municipality______________________ Province _______________________________
Area _______________ ( in hectares)

B. Improvements introduced in the Area.

B.1 Infrastructures:

Type of improvement Dimension of introduced Previous Current Amount

introduced improvements Year Year Value in
(P)

B.2 Plantation Established:

Name of Area planted Volume harvested

Species (in has.) (in kilograms)
1.
2.
3.
4.
5.
C. Government share paid (indicate O.R. No., date and amount paid) __________________.

D. Other Activities:

This is to certify that the above data and information are true and correct to the best knowledge of
the undersigned.
______________________________________
Signature of the AGREEMENT holder

Subscribed and Sworn to before me this ______ day of_______, 200___, affiant,
__________ exhibited to me his/her Community Tax Certificate No. __________ issued at
____________ on ___________________ and TIN No. ________, who executed the foregoing
report, and acknowledge to me his free that the same are true and correct to the best of his/her
knowledge.

________________________
CENRO/PENRO/RED
(As the case maybe)

Copy Furnished:
CENRO
PENRO
RED
FMB, DIRECTOR

11
SECRETARY

Annex “F”

COMPREHENSIVE DEVELOPMENT AND MANAGEMENT PLAN FOR SPECIAL FOREST

LANDUSE AGREEMENT (FLAg)

1. Cover Sheet

Name of AGREEMENT Holder

Approximate Area

Location:

Region
Province
Municipality(s)
Barangay(s)
Sitios

Boundaries:

Coordinates N: _______
E :_______
S: _______
W:_______

Physical description:

_____________________________
_____________________________

Submitted by:

___________________
AGREEMENT Holder

Date:_______________

12
2. Introduction
3. Objectives:
3.1 General Objectives
3.2 Specific Objectives
4. Area Description:
4.1 Location
4.2 History of the area
4.3 Topography
4.4 Drainage
4.5 Climate
4.6 Geology of soil
4.7 Vegetation and Forest cover
4.8 Forest Resource Data
4.9 Demographics and community descriptions
4.10 Infrastructure and utilities
4.11 Environmental Information
4.12 Security
4.13 Other Information
5. Development Plan:
5.1 General Strategy
5.2 Boundary and maintenance
5.3 Infrastructure Development
5.3.1 Permanent Improvements
5.3.2 Temporary Improvements
5.3.3 Other Improvements
6. *In Case of Nipa and Herbal/Medicinal Plantation
6.1 Seed procurement
6.2 Nursery operations
6.3 Plantation Establishment and Maintenance
6.4 Plantation Protection
6.5 Harvesting and Transport
7. Monitoring and evaluation
8. Market & Utilization:
8.1 Market Information
8.2 Utilization
9. Organization:
9.1 Company organization
9.2 Project organization
9.2.1 Staff
9.2.2 Labor
10. Financial Aspects:
10.1 Costs
10.1.1 Development
10.1.2 Post Development Phase
10.2 Sources of Finance
10.3 Returns
10.4 Financial analysis

11. Appendices
11.1 Maps

11.1.1 General location with technical description (Survey data)

11.1.2 Roads and Infrastructure Developments
11.1.3 Plantation Establishment (if applicants).

13
 ANNEX “F-1”

CONTENT OF THE INITIAL ENVIRONMENTAL EXAMINATION (IEE)

The following shall be the minimum requirement and format of the IEE

A. COMMUNICATION OF RESULTS.

1. Table of contents
2. Executive summary (brief subscription of the substantive content)
3. List of IEE preparers and their respective area in the IEE
4. Sworn accountability statement of key IEE preparer
5. Sworn accountability statement of project proponent
6. Process documentation
7. Proof of social acceptability
8. Certificate of Locational viability/locational clearance or zoning certificate
9. Reference/bibliography

B. SUBSTANTIVE CONTENT.

1. Project Description to include:

 Description and map of project location

 Project purpose/rationale
 General description of project design/plan
 Description of components and activities by the development phase

…. Pre-construction Phase
…. Operation Phase
…. Abandonment Phase

2. Methodology for data gathering to include process and content description of:

 Secondary data gathered and sources

 Primary baseline data
 Public consultations
 Process documentation of consultative activities

3. Description of Environment setting and receiving environment:

 Delineation/mapping of primary and secondary impact areas

 Description of existing biophysical environment
 Description of existing socio-cultural-economic environment
 Discussion of future environment conditions without the project

4. Impact Identification and Assessment:

 Summary matrix of predicted environment issues/impact and their level

of significance at various stages of development
 Brief discussion of significant impact on the physical and biological
resources
 Brief discussion of significant socio-economic effects/impacts of the
project including discussion of gender issues and population impact

5. PROJECT AREA AND SPACE ALLOCATION.

Indicate in a plan the are covered by the project claim in hectares in the same
scale as in item No. 3 showing the allocation of various area, classification of the
subdivision, the unit lot area allocation, & grouping of the type of the building, commercial
area, intend open space allocation like playground, road networks, domestics and
electric power sourcing, domestic waste water treatment ,solid waste disposal, space
allocation for septic tanks either communal or individual, etc.

6. PROJECT CONSTRUCTION ACTIVITIES.

Submit a flow chart showing actual sequence of project activities, in every stage
of the flow chart, indicate the work force resources needed the volume or amount of
materials extracted if any, to accomplish phase activities and the cost of each phase
should be submitted, A textual description of the flow chart should be provided.

7. PROJECT MAINTENANCE THROUGHOUT ITS LIFESPAN.

Include and describe the maintenance of the project and its surrounding
including its Aesthetic value.

14
 8. SOURCE OF ENVIRONMENTAL IMPACTS.

Identify all possible sources of environmental impacts during the entire project
style.

8.1 During construction stage (from the site clearing, earth movement due to
stripping, ground surface leveling, resultant effect of flood water during
heavy rains and typhoons to the water bodies.

8.2 After construction stage (domestic and/or industrial effluent, solid waste).

8.3 Social environmental impacts (effects of pollution and community growth

on transportation, school, market, church, hospital and health clinic
facilities, recreational space facilities, community and social relationship.
Water and power supply.

9. ENVIRONMENTAL MANAGEMENT MEASURES.

Identify and discuss the measures to minimize adverse environmental impacts

caused by the above-mentioned described factors (e.g. soil, erosion, land slides, solid
waste disposal, domestic and industrial pollution, etc.) Also indicate stockpile area for
waste and measures and minimize adverse effects of rub-off.

10. SIGNATURE OF PROJECT OF PERSON PREPARING THE INITIAL

ENVIRONMENTAL EXAMINATION.

ADDITION TO THE PROJECT DESCRIPTION

1. 1:10,000 topographic map or vicinity map. The map should be able to show other land
uses in the vicinities, e.g. other residential areas, agriculture, commercial, industrial, etc.,
if possible, this should be color coded to facilitate review.

2. DESCRIPTION OF ENVIRONMENTAL SETTING.

A. A description of the existing environmental conditions in the proposed site

should accompany the map submitted. Emphases should be given on the following:

A.1 Nearby surface water bodies (quality, uses, classification, etc.)

A.2 Critical ecological system (mangrove, forest land, etc.)
A.3 Land Uses
A.4 Existing Environmental Problems. If any incidence of air and water
pollution, soil erosion, etc.)
A.5 Socio-Economic indicator

A.5.1 Total workforce to be employed by the project proponent

Personal : ______________
Laborers : ______________

A.5.2 Existing number of residents in effected areas (proposed site)

3. ENVIRONMENTAL MANAGEMENT PLAN:

 Summary matrix of proposed mitigation and enhancement

measure estimated cost and responsibilities
 Brief discussion of mitigation and enhancement
 Monitoring Plan
 Contingency Plan (if applicable)
 Institutional responsibilities and agreement

4. RECOMMENDATION:

 List of resolved issues

 List of partially resolved issues
 New issues arising from the IEE that have been resolved

NOTE:

All document in ten (10) legible copies and complete electronic file in computer diskettes
shall be submitted.

Procedural Screening Fee…………… P 200.00

Filling Fee……………………………… P 460.00
Processing Fee……………………….. 2,100.00
Legal and Research Fee…………….. 240.00
Total ______________
P 3,000.00
15
 ============

16